Provider Demographics
NPI:1598224354
Name:MATT, MICHAEL GERMAIN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GERMAIN
Last Name:MATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:MLC 4010
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-3316
Mailing Address - Fax:513-636-5568
Practice Address - Street 1:3333 BURNET AVENUE
Practice Address - Street 2:MLC 4010
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3039
Practice Address - Country:US
Practice Address - Phone:513-636-3316
Practice Address - Fax:513-636-5568
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program